Enough delays on PMTCT - Doctors


President of the society, which has over 12 000 members throughout the Southern African region, Dr Francois Venter said the South African guidelines for the PMTCT have not been revised since 2001, despite multiple revisions to recommended protocols by international agencies, including the World Health Organisation.Health department spokesperson Sibane Mngadi said this week that a special National Health Council meeting would endorse the revised guidelines on Friday. This would see a short-course of AZT being added to the current regimen of single-dose Nevirapine. Paediatric HIV has almost been eradicated in many countries in the world. Poorer countries with far worse infrastructure than South Africa have made significant progress in decreasing transmission. 

In South Africa, a middle income country where the majority of women give birth in state facilities, the fact that HIV-infected women have access to a sub-standard regimen for protection of their children is a sad reflection on our health system, said Venter. In a short media statement Venter supported the Treatment Action Campaigns call for the rapid application of new guidelines, and echoed their support for medical professionals to utilise better regimens in the absence of a go-ahead from the health department. These guidelines have been promised repeatedly and have been widely consulted, yet have not been released, meaning that children continue to be infected unnecessarily. Many provincial departments of health and health professionals have expressed frustration to our Society at not receiving formal permission to implement improved guidelines, said Venter. Venter also called for more focused attention on HIV-infected pregnant women and their needs for HIV care and antiretrovirals. 

HIV is now the commonest cause of death amongst pregnant women. Almost 1 in 3 pregnant women are HIV positive in South Africa, yet HIV testing, CD4 staging, opportunistic illness prevention and initiation of appropriate antiretroviral therapy remain unacceptably low, in both the public and private sector. Women continue to place their trust in the health system. Some provinces have applied better antiretroviral regimens for PMTCT for years. It is completely unacceptable that children become HIV infected due to the inability of the Department to finalise a relatively simple change in a PMTCT regimen that has international support and extensive local experience, said Venter.